A cost comparison of a basal–bolus regimen (glargine and glulisine) with a premixed insulin regimen in type 2 diabetes patients: the GINGER study

Objective To investigate the comparative costs of two different insulin regimens in type 2 diabetes based on data from the GINGER study, which investigated the efficacy and safety of an intensified insulin regimen. Methods GINGER (Glulisine in Combination with Insulin Glargine in an Intensified Insulin Regimen) was a 52-week open label multinational study in 310 type 2 diabetes patients (glycated haemoglobin A1C (HbA1C) 7.5–11.0%) treated with insulin ± metformin who were randomly allocated to a basal–bolus (glargine–glulisine) regimen or to continue with two injections per day of premixed insulin (neutral protamine hagedorn + regular insulin/insulin aspart). The cost analysis, comparing glargine–glulisine with biphasic insulin aspart (BIA) substituted for both premixes, was undertaken from a UK National Health Service perspective. Results The annual insulin cost per patient on glargine–glulisine (£691) was higher than BIA (£592). The cost of needles, lancets and test strips was lower for BIA than for glargine–glulisine due to fewer injections. The total annual cost per patient receiving glargine–glulisine was £1,244 compared with £939 for BIA. Over 52 weeks the relative cost of a 1% reduction in HbA1C was £950 for glargine–glulisine and £1,173 for BIA. Conclusion A similar reduction in HbA1C and fasting plasma glucose can be achieved at a relatively lower cost with glargine–glulisine compared with premixed insulins.